新辅助治疗后 CA19-9 反应对胰腺癌患者的预后价值：系统评价和荟萃分析。

The prognostic value of CA19-9 response after neoadjuvant therapy in patients with pancreatic cancer: a systematic review and pooled analysis.

机构信息

Department of General Surgery, Peking University Third Hospital, 49 Huayuan Bei Lu, Haidian District, Beijing, People's Republic of China.

出版信息

Cancer Chemother Pharmacol. 2020 Dec;86(6):731-740. doi: 10.1007/s00280-020-04165-2. Epub 2020 Oct 12.

DOI:10.1007/s00280-020-04165-2

PMID:33047181

Abstract

BACKGROUND

Pancreatic cancer (PC) is a highly aggressive and refractory disease, with disappointing 5-year survival rates. Regarding the wide application of neoadjuvant treatment in patients with PC, how the post-neoadjuvant Carbohydrate antigen 19-9 (CA19-9) response could translate into a survival benefit is not clearly understood. We aimed to evaluate the correlation of the CA19-9 response with overall survival (OS) in patients with PC receiving neoadjuvant therapy.

METHODS

An extensive electronic search in PubMed, Embase, and the Cochrane Library was performed to identify relevant articles, from which data relevant to independent correlations of the CA19-9 response with overall survival (OS) were extracted for analysis. A random-effects model was used to calculate the pooled hazard ratios (HRs) with their corresponding 95% confidence intervals (CIs).

RESULTS

Altogether, 17 eligible studies were identified in the systematic review. Pooled analysis showed that CA19-9 response > 50% (HR, 0.43; 95% CI 0.29-0.56; P < 0.001) and normalization of CA19-9 (HR, 0.52; 95% CI 0.42-0.63; P < 0.001) after neoadjuvant treatment are significantly associated with promising overall survival. The results also showed that optimal CA19-9 response after neoadjuvant treatment was significantly related to a favorable prognosis (HR = 0.49, 95% CI 0.42-0.55, P < 0.001; I2 = 45.1%, P = 0.04). Subgroup analysis revealed there were no prognostic difference between CA19-9 > 50% and normalization of CA19-9 after neoadjuvant treatment (P = 0.338), but the duration of neoadjuvant chemotherapy over 4 months was significantly associated with expanded postoperative survival (P = 0.013).

CONCLUSIONS

Serum CA19‑9 is valuable in determining the effect of neoadjuvant treatment in patients with PC. Post-neoadjuvant CA19-9 response > 50% or CA19-9 normalization was related to a more promising overall survival, suggesting that optimal CA19-9 response may be a suitable prognostic index to guide treatment decisions.

摘要

背景

胰腺癌（PC）是一种侵袭性和难治性很强的疾病，其 5 年生存率令人失望。鉴于新辅助治疗在 PC 患者中的广泛应用，新辅助治疗后 CA19-9 应答如何转化为生存获益尚不清楚。我们旨在评估新辅助治疗的 PC 患者的 CA19-9 应答与总生存期（OS）的相关性。

方法

在 PubMed、Embase 和 Cochrane Library 中进行了广泛的电子检索，以确定相关文章，并从中提取与 CA19-9 应答与总生存期（OS）的独立相关性相关的数据进行分析。使用随机效应模型计算汇总风险比（HRs）及其相应的 95%置信区间（CIs）。

结果

系统评价中共确定了 17 项符合条件的研究。汇总分析表明，CA19-9 应答>50%（HR，0.43；95%CI 0.29-0.56；P<0.001）和新辅助治疗后 CA19-9 正常化（HR，0.52；95%CI 0.42-0.63；P<0.001）与有希望的总生存期显著相关。结果还表明，新辅助治疗后最佳 CA19-9 应答与良好的预后显著相关（HR=0.49，95%CI 0.42-0.55，P<0.001；I2=45.1%，P=0.04）。亚组分析显示，新辅助治疗后 CA19-9 应答>50%与 CA19-9 正常化之间无预后差异（P=0.338），但新辅助化疗持续时间超过 4 个月与术后生存期延长显著相关（P=0.013）。